Nutritional Influences on “Cell Refuse Disposal”

Beyond Obesity

Non-communicable diseases  (NCD) are the main causes of death in developed countries and are largely associated with aging.  The worrying trend is that they becoming more common in younger age groups and the increase in life expectancy we have seen in people born in the 1920’s and 1930’s will likely be reversed in the age group born in the 60’s, 70’s & 80’s caught up in the obesity epidemic (1).  Obesity is a risk factor for NCD but does not explain the cause as NCD are also the major killers of normal weight people as well.  The difference between long living mammals such as naked mole rats and their shorter live cousins is thought to be due to their superior cellular protection and repair processes (2) and age related diseases in humans may be related to deficiencies in these processes too.

Constant Turnover of Protoplasm

The material makeup of living things is gradually broken down and rebuilt on a daily cycle resulting in profound changes over time during the different phases of life from growth and development to the long involutionary period of aging in adulthood (3). Cleaning up residual protein fragments generated as a byproduct of metabolism is thought to be the underlying function of sleep in virtually all animals (4) and explains the molecular basis of impairment associated with sleep deprivation.  Efficient removal of protein residues is an essential life function and the regulation of these processes is inextricably tied up with nutritional status of cells (5) as is the protein synthesis side of the recycling equation (6).  Autophagy or “self-eating” is the term given to cell refuse disposal and is regulated by recognition of the fasting (7) and feeding cycles, which is dependent on glucose abundance in foods. In this way glucose abundance in the diet can be linked to underlying causes of NCD (8).

Health Benefits of Calorie Restriction: 

It is generally agreed that over-nutrition is responsible for obesity, diabetes and many age related diseases and it is well known that calorie restriction, even intermittent fasting, benefits all of these things and it is thought that possibly the main mechanism of these benefits is due to up-regulation of autophagy (9) which recycles redundant, potentially toxic material (10). Sensing mechanisms of nutritional status trigger cell signaling that regulates basal autophagy where survival requires mobilization of body stores during fasting.  Fat mobilization (lipophagy) takes place by a process akin to autophagy (11) and mobilization of glucose from glycogen is also accomplished via autophagy (12).  It may be an opportunist adaption of evolution that autophagy is employed for mobilization of substrate stores during fasting as well as protein recycling and intracellular “refuse disposal” processes.  Feeding inhibits and fasting stimulates autophagy through the actions of insulin and glucagon respectively and the primary determinant of insulin and glucagon secretion is blood glucose.  Insulin and glucagon control autophagy via their opposing effects on mTOR (mammalian target of rapamycin) whereby mTOR activity suppresses autophagy (5).  Glucagon via glucagon receptor activates adenylate cyclase which increases cAMP and activates PKA (cAMP activated protein kinase) which inhibits mTOR thereby stimulating autophagy in situations of fasting.  On the other hand glucose stimulated insulin secretion suppresses autophagy via Akt (PKB) activation of mTOR.  A ketogenic diet was found to inhibit the mTOR pathway via decreased Akt signaling as well as increased AMPK signaling in the liver of rats (13).  Through similar pathways Insulin and glucagon also have a role in regulating mitochondrial biogenesis.  Mitochondrial biogenesis is regulated by the master-controller, PGC1 nuclear receptor coactivators.  Fernandez and Auwerx (14) discovered how the pancreatic hormones insulin and glucagon play an opposing role in PGC1a transcription.  Insulin secretion which by activating Akt(PKB) depresses mitochondrial biogenesis by inhibiting PGC1a transcription while PGC1a transcription is increased via the glucagon receptor-PKA pathway.

NRF2:  Recent research by Rochelle Buffenstein’s group into the differences between long lived species the naked mole rat with a 40 year maximum life expectancy compared with 4 years in their short lived relatives, focuses on their superior detoxification and repair abilities largely mediated by the master controller NRF2 (NFE2L2) enhancing transcription of multiple proteins involved in cell protection and detoxification as well as chaperones involved in autophagy and protein stability (2).  The activity of two master controller transcription factors NRF2 and PGC1a appear to function in tandem, as they are increased by the same environmental stimuli and cell signaling pathways regulating multiple genes involved in autophagy (15) and mitochondrial regeneration (14) respectively.  Both NRF2 and PGC1a are increased by a ketogenic diet (16) (17) (18).

AMPK    Another sensor of cellular energy levels is AMP activated protein kinase (AMPK) functions in a different way to the glucagon receptor activated cyclic AMP activated protein kinase (PKA).  AMPK responds to increased AMP/ATP levels that occur with exercise.  A recent review highlights a central role for AMPK in disease resistance and longevity (19) promoting transcription of FOXO dependent proteins such as PGC1a and NRF2 while promoting autophagy by inhibiting mTOR.  Of particular relevance to the mechanism of ketogenic diets is that insulin signaling powerfully suppresses AMPK activation via Akt/PKB (20) while glucagon activates AMPK by activating CaMKIV (21)

Autophagy is induced with ketogenic diet

Because a ketogenic diet profoundly suppresses insulin secretion even in the presence of adequate calorie intake (22) it follows that ketogenic diets enhance basal autophagy (13).  A ketogenic diet as in fasting also requires glucose production from glycogenolysis and gluconeogenesis which is controlled be glucagon secretion which via the PKA pathway suppresses mTOR to enhance autophagy and on the other hand carbohydrate foods that increase glucose and insulin levels activate mTOR via akt/PKB pathway to suppress basal autophagy.


Widespread appreciation of the emerging importance of autophagy in life and disease is likely to focus attention on ways to optimize these processes and macronutrients and phytonutrients have a profound impact as seen from the lessons from epidemiological and basic science studies on restriction of glucose abundance through low glycemic and ketogenic diets (23).

Works Cited

1. A Potential Decline in Life Expectancy in the United States in the 21st Century. S. Jay Olshansky, Ph.D., Douglas J. Passaro, M.D., Ronald C. Hershow, M.D.,Jennifer Layden, M.P.H., Bruce A. Carnes, Ph.D., Jacob Brody, M.D., Leonard Hayflick, Ph.D.,Robert N. Butler, M.D., David B. Allison, Ph.D., and David S. Ludwig, M.D., Ph.D. s.l. : n engl j med, 352;11, March 17, 2005.

2. Viviana I. Pereza, Rochelle Buffenstein, Venkata Masamsetti, Shanique Leonard, Adam B. Salmon, James Meleb, Blazej Andziakd, Ting Yangd, Yael Edreyd, Bertrand Friguete, Walter Ward, Arlan Richardsona, and Asish Chaudhur. Protein stability and resistance to oxidative stress are determinants of longevity in the longest-living rodent, the naked mole rat. s.l. : PNAS March 3, 2009 vol. 106 no. 9 3059–3064.

3. Li-qiang HE, Jia-hong LU, Zhen-yu YUE. Autophagy in ageing and ageing-associated diseases. . s.l. : Acta Pharmacologica Sinica (2013) 34: 605–611; ; published online 18 Feb 2013. doi: 10.1038/aps.2012.188.

4. Varshavsky., Alexander. Augmented generation of protein fragments during wakefulness as the molecular cause of sleep: a hypothesis. . s.l. : PROTEIN SCIENCE 2012 VOL 21:1634—1661 Published by Wiley-Blackwell. VC 2012 The Protein Society.

5. Rajat Singh, Ana Maria Cuervo. Autophagy in the Cellular Energetic Balance. . s.l. : Cell Metab. 2011 May 4; 13(5): 495–504. doi:10.1016/j.cmet.2011.04.004.

6. Carles Canto, Johan Auwerx. PGC-1a, SIRT1 and AMPK, an energy sensing network that controls energy expenditure. s.l. : Current Opinion in Lipidology 2009, 20:98–105.

7. Mehrdad Alirezaei, Christopher C. Kemball, Claudia T. Flynn, Malcolm R. Wood, J. Lindsay Whitton, William B. Kiosses. Short-term fasting induces profound neuronal autophagy. s.l. : Autophagy 6:6, 702-710; August 16, 2010; © 2010 Landes Bioscience.

8. Livesey G, Taylor R, Livesey H, Liu S. Is there a dose-response relation of dietary glycemic load to risk of type 2 diabetes? Meta-analysis of prospective cohort studies. . s.l. : Am J Clin Nutr. 2013 Mar;97(3):584-96. doi: 10.3945/ajcn.112.041467. Epub 2013 Jan.

9. Autophagy and Aging. David C. Rubinsztein, Guillermo Marin, Guido Kroemer. s.l. : Cell 146, September 2, 2011 Elsevier Inc. DOI 10.1016/j.cell.2011.07.030.

10. Selective degradation of mitochondria by mitophagy . Insil Kim, Sara Rodriguez-Enriquez, John J. Lemasters. s.l. : Archives of Biochemistry and Biophysics , 2007, Vols. 462 (2007) 245–253.

11. H. Knævelsrud, A. Simonsen,. Lipids in autophagy: Constituents, signaling molecules and cargo with relevance to disease,. s.l. : Biochim. Biophys. Acta (2012), . doi:10.1016/j.bbalip.2012.01.001.

12. O.B. Kotoulas, S.A. Kalamidas, D.J. Kondomerkos. Glycogen autophagy in glucose homeostasis. s.l. : Pathology – Research and Practice 202 (2006) 631–638.

13. Sharon S. McDaniel, Nicholas R. Rensing, Liu Lin Thio, Kelvin A. Yamada, and Michael Wong. The ketogenic diet inhibits the mammalian target of rapamycin (mTOR) pathway. . s.l. : Epilepsia. 2011 March ; 52(3): e7–e11. doi:10.1111/j.1528-1167.2011.02981.x.

14. Pablo J Fernandez-Marcos, and Johan Auwerx. Regulation of PGC-1a, a nodal regulator of mitochondrial biogenesis. s.l. : Am J Clin Nutr 2011;93(suppl):884S–90S.

15. Kaitlyn N. Lewis, James Mele, John D. Hayes and Rochelle Buffenstein. Nrf2, a Guardian of Healthspan and Gatekeeper of Species Longevity. s.l. : Integrative and Comparative Biology, volume 50, number 5, pp. 829–843.

16. Julie B. Milder, Li-Ping Liang and Manisha Patel. Acute oxidative stress and systemic Nrf2 activation by the ketogenic diet. s.l. : Neurobiology of Disease 2010: Volume 40, Issue 1, 238-244.

17. Bough, Kristopher. Energy metabolism as part of the anticonvulsant mechanism of the ketogenic diet. s.l. : Epilepsia 2008, 49: 91-93.

18. Douglas Wallace, Weiwei Fan, Vincent Procaccio. Mitochondrial Energetics and Therapeutics. s.l. : Annual Review of Pathology: Mechanisms of Disease 2010 5:297-348, 2010.

19. Antero Salminen, Kai Kaarniranta. AMP-activated protein kinase (AMPK) controls the aging process via an integrated signaling network. s.l. : Ageing Research Reviews 11 (2012) 230– 241.

20. Suzanne Kovacic, Carrie-Lynn M. Soltys, Amy J. Barr, Ichiro Shiojima, Kenneth Walsh and Jason R. B. Dyck. Akt Activity Negatively Regulates Phosphorylation of AMP-activated Protein Kinase in the Heart. s.l. : The Journal of Biological Chemistry, 2003: 278, 39422-39427.

21. I-Chen Peng, Zhen Chen, Pang-Hung Hsu, Mei-I Su, Ming-Daw Tsai and John Y-J. Shyy. Glucagon Activates the AMP-Activated Protein Kinase/Acetyl-CoA Carboxylase Pathway in Adipocytes. s.l. : FASEB J.April 201024 (Meeting Abstract 995.4).

22. Adam R. Kennedy, Pavlos Pissios, Hasan Otu, Bingzhong Xue, Kenji Asakura, Noburu Furukawa, Frank E. Marino, Fen-Fen Liu, Barbara B. Kahn, Towia A. Libermann, Eleftheria Maratos-Flier. A high-fat, ketogenic diet induces a unique metabolic state in mice. s.l. : Am J Physiol Endocrinol Metab 292:E1724-E1739, 2007. First published 13 February 2007;.

23. Marwan A Maalouf, Jong M Rho, Mark Mattson. The neuroprotective properties of calorie restriction, the ketogenic diet and ketone bodies. s.l. : Brain Res Rev 2009: March 59: 293-315.



Calorie Counting

Calorie Hypothesis of Obesity

Everyone knows starvation makes you thin and overeating makes you fat and the “calorie in calorie out” theory of weight control is at the heart of nutritional advice and food labelling, nevertheless for many reasons counting calories usually fails over the long term. Calorie restriction no doubt has health benefits but a lifetime of hunger is not likely to catch on with most people. We eat food not calories and there are staggering numbers of possible food combinations to choose that can have distinct effects on appetite, physiological responses and cell signaling. There are physical limitations to consuming plant foods with high fiber and water content (1) and there is evidence to suggest hunger is accentuated when attempting calorie restriction with diets containing high glycemic filler foods like bread, potatoes, rice, pasta, flour and sugar as opposed to high fiber (2) and ketogenic diets (3) (4) (5)

On the other side of the equation calories out is equally complicated with physical activity, heat generation, work of metabolism, growth and development, healing processes, calorie losses in faeces and urine all having significant effects.

Exercise is a highly beneficial activity but the impact of exercise on “calories out” is commonly overestimated, and exercise alone is unlikely to reverse obesity unless you put in the sort of time required of professional athletes.  For instance resting energy expenditure is typically 100 Calories per hour and the most vigorous exercise would expend 10 times that figure while moderate exercise increases to 3 to 4 times resting metabolic rate, so that 30 minutes of moderate exercise results in additional calories out of around 150 Cals the equivalent of 17 gms of fat.

Faecal loss of calories is frequently underestimated particularly so with increased faecal output from high fiber consumption (6).  Calorie content of faeces is around 2 Cals per gm (7) and the typical low fiber Western Diet (10-15 gms/d) might be associated with a faecal output of 100 g/day and this could rise to 200-400 g/d with recommended (35 g/d) or even higher fiber intakes (6) which may result in faecal calorie output of between 400 and 800 Cals/day.  Studies have indicated a 1 g/d increase in fiber results in a 5 gm/d increase in stool weight but of that the calorie content, particularly from fat, increases proportionately more (8).

Resting energy expenditure varies considerably with stages in life; proportionately much higher with growth and development, levelling off in adulthood and progressively declining with age.  There is a well-known thermal effect of foods whereby energy expenditure increases after meals proportionately with calorie content although, in experimental rodents a ketogenic diet increases oxygen consumption and causes weight loss in spite of increased calorie intake (9) although this has not been clearly demonstrated in human studies there are mechanisms related to energy uncoupling through fatty acid metabolism and up-regulation of uncoupling proteins to explain how these things might happen.  In addition, there have been many studies comparing unrestricted ketogenic diets with calorie restricted low fat diets for weight loss and most have shown greater weight loss with ketogenic diets despite higher calorie intake (10) (11) (1).

Works Cited

1. D J A Jenkins, J M Wong, CWC Kendall, A Esfahani, T Leong, DA Faulkner, E Vidgen, KA Greaves, G Paul, W Singer. The effect of a Plant based low carbohydrate (ECO-Atkins) diet of body weight and blood lipid concentrations in hyperlipidemic subjects. s.l. : Arch Intern Med 169: 11 June 8, 2009 1046-1054, 2009.

2. Elin V Johansson, Anne C Nilsson, Elin M Östman and Inger M E Björck . Effects of indigestible carbohydrates in barley on glucose metabolism, appetite and voluntary food intake over 16 h in healthy adults. . s.l. : Nutrition Journal 2013, 12:46.

3. P Sumithran, LA Prendergast, E Delbridge, K Purcell, A Shulkes, A Kriketos, J Proietto. Ketosis and appetite-mediating nutrients and hormones after weight loss. . s.l. : European Journal of Clinical Nutrition (2013) 67, 759–764; doi:10.1038/ejcn.2013.90;.

4. Margriet A. B. Veldhorst1, Klaas R. Westerterp, Anneke J. A. H. van Vught, Margriet S. Westerterp-Plantenga. Presence or absence of carbohydrates and the proportion of fat in a high-protein diet affect appetite suppression but not energy expenditure in normal-weight human subjects fed in energy balance. s.l. : British Journal of Nutrition 2010: 1-11 doi:10.1017/S000711451000206.

5. SCHARRER, ERWIN. Control of Food Intake by Fatty Acid Oxidation and Ketogenesis. . s.l. : Nutrition Vol. 15, No. 9, 1999.

6. K. L. Wrick, J. B. Robertson, P. J. Van Soest, B. A. Lewis, J. M. Rivers, D. A. Roe, L. R. Hackler. The Influence of Dietary Fiber Source on Human Intestinal Transit and Stool Output. . s.l. : J. Nutr. 113: 1464-1479, 1983.

7. J L Murphy, S A Wootton, S A Bond, A A Jackson. Energy content of stools in normal healthy controls and patients with cystic fibrosis. . s.l. : Archives of Disease in Childhood 1991; 66: 495-500.

8. Hsiao-Ling Chen, Valerie S Haack, Corey W Janecky, Nicholas W Vollendorf, Judith A Marlett. Mechanisms by which wheat bran and oat bran increase stool weight in humans. . s.l. : Am J Clin Nutr 1998;68:711–9.

9. Adam R. Kennedy, Pavlos Pissios, Hasan Otu, Bingzhong Xue, Kenji Asakura, Noburu Furukawa, Frank E. Marino, Fen-Fen Liu, Barbara B. Kahn, Towia A. Libermann, Eleftheria Maratos-Flier. A high-fat, ketogenic diet induces a unique metabolic state in mice. s.l. : Am J Physiol Endocrinol Metab 292:E1724-E1739, 2007. First published 13 February 2007;.

10. Jeff S Volek, Richard D Feinman. Carbohydrate restriction improves the features of Metabolic Syndrome: Metabolic Syndrome may be defined by the response to carbohydrate restriction. s.l. : Nutrition & Metabolism 2005: 2:31, 2005.

11. Eric C Westman, William S Yancy Jr, John C Mavropoulos, Megan Marquart and Jennifer R McDuffie. The effect of a low-carbohydrate, ketogenic diet versus a low fat diet to treat type 2 diabetes. s.l. : Nutrition & Metabolism 2008 5:36, 2008.